HORMONAL HAPPY HOUR

I almost accidentally careened my car
into the icy waters of the Ohio River after driving past a billboard the other
day. The cause of this near-tragic automobile accident was in response to the
message of the advertisement: “Are you over 35 with a waning libido, expanding
waistline and suffering from lack of sleep? Maybe it's hormonal.”
Hormonal? Clearly, I misread.

Well, it's possible some assemblage of
those questions may elicit a personal "yes" in reply, but still,
isn't 35 kind of young for hormone issues? Don’t I have a few years before
menopause and having to worry about hormone replacement therapy?

WHAT IS HORMONE REPLACEMENT THERAPY?

According to the Centers for Disease
Control, hormone replacement therapy (HRT) has been prescribed to women to ease
the symptoms of menopause since the mid-1930s.

During menopause (and perimenopause),
the ovaries reduce their production of female hormones leading to hormone
withdrawal symptoms such as hot flashes, loss of libido, mood swings, hair
loss, weight gain and more. HRT supplements the waning progesterone and/or
estrogen levels with synthetic compounds absorbed through pill, patch or cream
form to help your body cope with the reduction.

In addition to easing the pain of
menopause, HRT has also been widely viewed as an anti-aging treatment thanks to
the 1960s book Feminine Forever, written by Dr. Robert A. Wilson, which
praised synthetic estrogen therapy as an effective way to stay youthful and
feminine. It also couched menopause in terms of an estrogen deficiency illness
that could be managed with HRT rather than viewing it as a normal stage in the
life cycle. The perceived added benefit of "youthfulness"greatly
increased the demand for HRT and brought it into the popular consciousness as
an anti-aging treatment.

Today, Suzanne Somers is the pop
culture equivalent of Dr. Wilson. She is one of the most outspoken supporters
of using HRT to “reverse the aging process” with books similar to Feminine
Forever touting the benefits of hormone replacement therapy. In her book, Ageless,
she claims HRT is an “inspiring, medically validated approach to reversing the
aging process and maintaining a healthy, vibrant, mentally sharp, sexually
active life.” And, with the support of influential figures like Oprah, she’s
been telling American women to look to hormonal imbalance for many of their
physical and emotional problems. Her twist? Instead of synthetic hormones, she supports
bioidenticals.

BIOIDENTICAL HORMONES

Bioidentical Hormone Replacement
Therapy (BHRT) is a different breed of hormone therapy that has become
increasingly attractive to consumers in reaction to the debate over the safety
of conventional hormone therapies.

Dr. Amy Brenner, a board-certified gynecologist
whose West Chester practice specializes in BHRT, defines
bioidenticals as: “An exact replica of the hormones that are produced in your
body.” The thinking goes that since bioidentical hormones, unlike synthetic
hormones, are metabolized identically to those made in the body, BHRT is
“better for you” than conventional hormone therapies.

In order to discern what BHRT treatment
is recommended for patients, the body’s current levels of progesterone and
estrogen must be assessed. The method preferred by Dr. Brenner and the lion’s
share of bioidentical providers for ascertaining these values is a saliva test:
You spit into a vial and they ship it to a lab.

Why spit, you ask? The argument is that
blood-test values can only assess an extreme absence or overabundance of
hormones rather than the more-subtle fluctuation levels bioidentical practitioners
are looking to tweak. Therefore, spit is preferable to blood as it allows for
finer distinctions.

This is a contentious testing method,
though. Many experts point to the fact that hormone levels vary widely
throughout the day making such subtle values difficult to interpret. Also at
issue is the fact that the lab that runs the test and sells the spit kit, ZRT
Laboratory, is the lab that decided what the “correct” hormone values should
be.

Along with Dr. Brenner, The Happy
Hormone Cottage is another local agency that will
help administer and interpret your spit kit. The Happy Hormone Cottage acts as
facilitator, counselor and educator for clients seeking BHRT.

“We believe education is key and gives
women the confidence to dialogue with their doctor and educate them on the
benefits [of hormone therapy],” says Lyn Hogrefe, the executive director of The
Happy Hormone Cottage.

When The Happy Hormone Cottage gets the
results of your spit kit, the information goes to a compound pharmacist
affiliated with the Happy Hormone practice. The pharmacist then draws up a
recommended plan of action based on your imbalance for you to bring to your
doctor who would then (upon approving the regimen) submit the prescription back
to that compound pharmacy to be filled.

A compound pharmacy crafts prescribed
medication customized to a patient allowing for a more individualized dosage
rather than providing pre-configured medication dosages (.25 mg, .5 mg, etc.)
like a regular pharmacy. The individualization of the treatment based on
personal test results is a benefit touted by supporters of BHRT. (But
detractors would point out that compound pharmacies are under scrutiny by the
FDA because of a sterile injectable issues last year that caused a fatal
outbreak of fungal meningitis.)

Like traditional hormone replacement
therapy, BHRT is administered through creams, pills, gels, vaginal rings and
transdermal patches with your personal regimen of hormone therapy determined by
your doctor and the test results. For example, every day Somers puts an
estrogen cream on her left arm, injects two milligrams of estriol (an estrogen
typically only produced in significant amounts during pregnancy) into her
vagina and then, for two weeks a month, puts a progesterone cream on her right
arm. The regimen, which she revealed on an episode of Oprah, sounds
complex and kind of odd, but testimonials of satisfied customers abound.

With BHRT, women report an increase in
energy, better mood stability, better sleep and improved cognitive functioning
in addition to relief from common menopausal symptoms. Studies also show that
visible skin aging, including wrinkles caused by low estrogen levels, can be
reversed with increased estrogen. BHRT can even make your hair more lush,
weight easier to lose and can increase your vocal richness.

And it’s not just the patients who love
it. In fact, Dr. Brenner and Hogrefe are such enthusiastic supporters of BHRT
that they are on the program themselves. And they both look fantastic. (Sorry,
had to be said.)

RISK-BENEFIT ANALYSIS

With all of these benefits, it’s
completely reasonable to wonder why our doctors are not handing out
prescriptions for hormone replacement therapy along with our annual flu shots.
And it’s because not all minds concur on the risk of either HRT or BHRT, and
more data would be nice, too.

After the immense commercial success of
Feminine Forever — whose author was later revealed to be in the pocket
of hormone-producing drug companies — and subsequent increase in demand for
HRT, people began to wonder what, if any, damage the synthetic hormones were
doing to women's bodies. In the 1970s, HRT's synthetic estrogen was shown to
elevate the risk of endometrial cancer, causing an uproar. But then, in the
1980s, HRT got back into good graces when the hormones were shown to protect
against osteoporosis and maybe heart disease. Today, the risk-benefit ratio is
again in question.

The National Institutes of Health's
Women’s Health Initiative conducted the first large scale, double-blind,
placebo-controlled clinical trials of HRT in healthy, post-menopausal women in
1991. The study was slated to continue for 15 years but was stopped prematurely
in 2002 when it found statistically significant increases in the rate of breast
cancer and vascular disease among test subjects who received Prempro (a
synthetic estrogen and progesterone compound). The threat of heart disease,
stroke, blood clots and cancer outweighed the possible good of HRT, so they
shut down the study.

And while the same large-scale tests
have not been conducted on BHRT, the thought is that the molecular difference
between bioidenticals and synthetic hormones is not enough to discount the
risks found in the Women’s Health Initiative study. (Although one study has
suggested that hormone patches and creams favored by bioidentical providers do
no carry the same risks for blood clots as do the more traditional HRT pill
delivery system).

Unfortunately, while proponents of
bioidentical hormones assert there are no risks with the therapy like there are
with conventional HRT, the lack of information on how the body interacts with
the two hormone formulas differently is a problem. The view of the medical
establishment is to assume the risks are the same for both, but Hogrefe
disagrees, saying that since her program doesn't use synthetic estrogens or
progestin (synthetic progesterone), they aren't concerned. But Dr. Brenner, who
fully supports BHRT, won't allow women with a personal history of breast cancer
to undergo bioidentical hormone therapy.

Today, before starting any type of
hormone replacement therapy, your doctor should evaluate your particular set of
health risk factors in conjunction with the severity of your symptoms when
devising a treatment plan.
The current, accepted treatment
practice for any hormone therapy is to take the lowest dose of hormones for the
shortest amount of time possible to achieve the desired outcome — although
women on bioidenticals commonly undergo hormone therapy for an indefinite
number of years with periodic testing and hormonal cocktail adjustments.

Despite the fact that we don't know all
of the risks involved with traditional HRT or bioidentical therapy, there are
undeniable perks of hormone replacement therapy that both sides recognize: It
lowers your chances of colorectal cancer, has therapeutic advantages for those
suffering from menopause symptoms and can help prevent osteoporosis.

TO YOUR HEALTH

With a bunch of promises and a bit of
risk, there’s ground to be gained with hormone therapy and the parting thought
is this: All of these professionals are there to help you. Doctors, educators,
pharmacists, all of them, will work with you and with one another to devise a
comprehensive strategy — and possibly a payment plan — particular to your
personal story to help you take charge of your physical health and well
being.

While
many of the opinions out there may differ, the unifying and sincere drive to
better women’s health is leading the discussion.